Then over a 12-hour period, they develop a vicious cycle of hypoxia, pulmonary vasocon- striction, pulmonary hypertension, and dilata- tion of the ductus arteriosus.

Despite interest in the use of vasodilators to relieve the pulmonary vasoconstriction and ar- rest the cycle, Dr Rowe said “results have been disappointing.” A small group of patients seem to do better, but the overall survival rate of the infants has not changed appreciably.

Extracorporeal membrane oxygenation is also being used for babies with congenital dia- phragmatic hernias. “If the lung will begin to grow and expand each day, what these babies need is a free ride,” Dr Rowesuggested. While the infant is on the heart-lung machine, the lungs are maintained on a ventilator. In one group of 13 babies maintained on the heart- lung machine for 253 hours, the overall mortal- ity was 46%. Dr Rowe felt this treatment was “encouraging.”

Reinforcing the importance of saving the

spleen, Dr Rowe said it was “bad business” to take out a traumatized spleen in a child. “What we are trying to do is avoid postsplenectomy sepsis.” Infants and children who have had splenectomies are more susceptible to severe bacterial infections, including septicemia, meningitis, and pneumonia.

Dr Rowe said about two-thirds of children who have obvious evidence of ruptured spleen do not require surgery. They can be managed by transfusion-ne complete blood volume exchange. Of those who do require surgery, the majority can undergo a spleen-sparing op- eration. As the best approach, Dr Rowe rec- ommended splenic repair by suturing or pedi- cle graft. The next best choice is partial splenectomy. He explained that the advantage of partial splenectomy is a large part of the spleen remains, and it is in the corporeal drainage and has the correct arterial supply. This is important in immunological defense.

Audiovisual review Body Image Development: A Life-long Process This color slideltape module was made in 1978 by Patricia Hebert, RN, and Kathleen Mikan, RN. In this 20-minute presentation, sexual roles follow common stereotyping-little boys play with trucks and cars, little girls play with dolls.

According to this program, development of correct sexual image depends on proper role playing by preschoolers and any deviation (for example, offering a doll to a boy) may cause confusion. The presentation also discusses the emphasis on youth in today’s culture, which contributes to many problems faced by older people as aging changes their body image.

Except for the sexual stereotyping, this program offers a good overview of body image perceived throughout life. It is easily understood by nonmedical persons and could be used as an introduction in discussions with parents or any adult group. However, the terminology used in discussing the older adult could be insulting to the 60-year-old in today’s society who does not care to be labeled as “elderly.”

To avoid the unwieldiness of “helshe” or the use of nonsexual pronouns, the script alternates gender. This leads to some ambiguity. At times, the gender pronoun is emphasized as if to imply the image being discussed is confined to one sex. At other times, gender changes back and forth, leaving the viewer to wonder if certain points are more important to one sex or are common to both.

The module does not go into sufficient depth to assist the OR nurse in understanding psychological trauma that might result from a changed body image due to surgical intervention, injury, or loss of a body part.

This slide/tape module may be purchased through the American Journal of Nursing Company, Educational Division, 555 W 57th St, New York, NY 10019. Purchase price is $60, but the module may be previewed for $10, which will be credited toward the purchase price.

Patricia Ball, RN, CNOR Audio,visual Committee

112 AORN Journal, January 1982, Vol35, No 1